Summary of findings for the main comparison. Strict bed rest with and without hospitalisation in multiple pregnancy for improving outcomes.
| Population: women with multiple pregnancy Setting: Australia, Zimbabwe Intervention: strict bed rest in hospital Comparison: no activity restriction at home | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with no activity restriction at home | Risk with strict bed rest in hospital | |||||
| Very preterm birth (less than 34 weeks) ‐ assuming complete correlation between twins/triplets | Study population | RR 1.02 (0.66 to 1.58) | 495 (5 RCTs) | ⊕⊕⊝⊝ Low 1,2 | ||
| 120 per 1000 | 123 per 1000 (80 to 190) | |||||
| Perinatal mortality ‐ assuming independence between twins/triplets | Study population | RR 0.65 (0.35 to 1.21) | 1016 (5 RCTs) | ⊕⊕⊝⊝ Low 1,2 | ||
| 47 per 1000 | 31 per 1000 (16 to 57) | |||||
| Low birthweight (less than 2500 g) ‐ assuming independence between twins/triplets | Study population | RR 0.95 (0.75 to 1.21) | 502 (3 RCTs) | ⊕⊕⊝⊝ Low 2,3,4 | ||
| 502 per 1000 | 477 per 1000 (376 to 607) | |||||
| Prelabour preterm rupture of the membrane | Study population | RR 1.30 (0.71 to 2.38) | 276 (3 RCTs) | ⊕⊕⊝⊝ Low 1,2 | ||
| 116 per 1000 | 151 per 1000 (82 to 276) | |||||
| Small‐for‐gestational age ‐ assuming independence between twins/triplets | Study population | RR 0.75 (0.56 to 1.01) | 293 (2 RCTs) | ⊕⊕⊝⊝ Low 1,2 | ||
| 442 per 1000 | 332 per 1000 (248 to 447) | |||||
| Psychosocial effects of bed rest (depression, anxiety, stress) | See comments | No studies reported this outcome | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Wide 95% CI with crossing the line with no effect (‐2).
2 We did not downgrade for the lack of blinding because the outcomes were not likely to be influenced by lack of blinding.
3 Wide 95% CI with crossing the line with no effect (‐1). 4 High heterogeneity (I² > 60%) (‐1).